Chiropractic

Chiropractic has proven in several studies to be less expensive than many more traditional routes such as outpatient physical therapy. Relief from some neuromuscular problems is immediate, although a series of chiropractic treatments is likely to be required to maintain the improvement. Spinal manipulation is an excellent option for acute lower back pain, and may also relieve neck pain as well as other musculoskeletal pain. Although most back pain will subside eventually with no treatment at all, chiropractic treatment can significantly shorten the time it takes to get relief. Some types of headache can also be successfully treated by chiropractic.

An initial chiropractic exam will most often include a history and a physical. The patient should be asked about what the current complaint is, whether there are chronic health problems, family history of disease, dietary habits, medical care received, and any medications currently being taken. Further, the current complaint should be described in terms of how long it has been a problem, how it has progressed, and whether it is the result of an injury or occurred spontaneously. Details of how an injury occurred should be given. The physical exam should evaluate by observation and palpation whether the painful area has evidence of inflammation or poor alignment. Range of motion may also be assessed. In the spine, either hypomobility (fixation) or hypermobility may be a problem. Laboratory analysis is helpful in some cases to rule out serious infection or other health issues that may require referral for another type of treatment. Many practitioners also insist on x rays during the initial evaluation

When spinal manipulation is employed, it is generally done with the hands, although some chiropractic practitioners may use an adjusting tool. A classic chiropractic adjustment involves a high velocity, low amplitude thrust that produces a usually painless popping noise, and improves the range of motion of the joint that was treated.

The patient may lie on a specially designed, padded table that helps the chiropractic practitioner to achieve the proper positions for treatment. Some adjustments involve manipulating the entire spine, or large portions of it, as a unit; others are small movements designed to affect a single joint. Stretching, traction, and slow chiropractic manipulation are other techniques that can be employed to restore structural integrity and relieve nerve interference.


Length of treatment: The number of chiropractic treatments required will vary depending on several factors. Generally longer-term chiropractic treatment is needed for conditions that are chronic, severe, or occur in conjunction with another health problem. Patients who are not in overall good health may also have longer healing times. Some injuries will inherently require more treatments than others in order to get relief. Care is given in three stages. Initially appointments are more frequent with the goal of relieving immediate pain. Next, the patient moves into a rehabilitative stage to continue the healing process and help to prevent a relapse. Finally, the patient may elect periodic maintenance, or wellness treatments, along with lifestyle changes if needed in order to stay in good health.

Follow-up care: Discharge and follow-up therapy are important. If an back injury occurred as a result of poor fitness or health, a program of exercise or nutrition should be prescribed. Home therapy may also be recommended, involving such things as anti-inflammatory medication and applications of heat or ice packs. Conscious attention to posture may help some patients avoid sustaining a similar injury in the future, and the chiropractor should be able to discern what poor postural habits require correction. A sedentary lifestyle, particularly with a lot of time spent sitting, is likely to contribute to poor posture and may predispose a person to back pain and injury.

Types of practitioners: Some practitioners use spinal manipulation to the exclusion of all other modalities, and are known as straight chiropractors. Others integrate various types of therapy such as massage, nutritional intervention, or treatment with vitamins, herbs, or homeopathic remedies. They also embrace ideas from other health care traditions. This group is known as mixers. The vast majority of chiropractors, perhaps 85%, fall in this latter category.

Preparations patients should enter the chiropractic clinic with an open mind. This will help to achieve maximum results.

Precautions: Chiropractic is not an appropriate therapy for diseases that are severely degenerative and may require medication or surgery. Many conditions of the spine are amenable to manipulative treatment, but that does not include fractures. The chiropractic practitioner should be informed in advance if the patient is on anticoagulants, or has osteoporosis or any other condition that may weaken the bones.

There are other circumstances that would contraindicate chiropractic care, and these should be detected in the history or physical exam. In addition to fractures, Down syndrome, some congenital defects, and some types of cancer are a few of the things that may preclude spinal manipulation. On rare occasions, a fracture or dislocation may occur. There is also a very slim possibility of experiencing a stroke as a result of spinal manipulation, but estimates are that it is no more frequent than 2.5 occurrences per one million treatments.

Be wary of chiropractors who insist on costly x rays and repeated visits with no end in sight. Extensive use is not scientifically justifiable, especially in most cases of lower back pain. There are some circumstances when x rays are indicated, including acute or possibly severe back injuries such as those that might result from a car accident.

Side effects: It is not uncommon to have local discomfort in the form of aches, pains, or spasms for a few days following a chiropractic treatment. Some patients may also experience mild headache or fatigue that resolves quickly.

Research & general acceptance: As recently as the 1970s, the American Medical Association (a national group of medical doctors) was quite hostile to chiropractic, which it deemed a cult. AMA members were advised that it was unethical to be associated with chiropractors. Fortunately that has changed, and as of the year 2000, many allopathic or traditionally trained physicians enjoy cordial referral relationships with chiropractors. The public is certainly strongly in favor of chiropractic treatment. An estimated 15% of people in the United States used chiropractic care in 1997. Chiropractors see the lion's share of all patients who seek medical help for back problems.

Chiropractic research has also supported the use of spinal manipulation for acute low-back pain. There is some anecdotal evidence recommending chiropractic treatment for ailments unrelated to musculoskeletal problems, but there is not enough research-based data to support this. On the other hand, a chiropractor may be able to treat problems and diseases unrelated to the skeletal structure by employing therapies other than spinal manipulation.

Although many chiropractors limit their practice to spine and joint problems, others claim to treat disorders that are not closely related to the back or musculoskeletal system These include asthma, bed-wetting, bronchitis, coughs, dizziness, dysmenorrhea, earache, fainting, headache, hyperactivity, indigestion, infertility, migraine, pneumonia, and issues related to pregnancy. There are at least three explanations for possible efficacy for these conditions. One is that the problem could be linked to a nerve impingement, as may be possible with bed-wetting, dizziness, fainting, and headache. In a second group, chiropractic treatment may offer some relief from complicating pain and spasms caused by the disease process, as with asthma, bronchitis, coughs, and pneumonia. The discomforts of pregnancy may also be relieved with gentle chiropractic therapy. A third possibility is that manipulation or use of soft-tissue techniques may directly promote improvement of some conditions. One particular procedure, known as the endonasal technique, is thought to help the eustachian tube to open and thus improve drainage of the middle ear. The tube is sometimes blocked off due to exudates or inflammatory processes. This can offer significant relief from earaches. Some headaches also fall in this category, as skilled use of soft tissue techniques and adjustment may relieve the muscle tension that may initiate some headaches.

Sysmenorrhea, hyperactivity, indigestion, and infertility are said to be relieved as a result of improved flow of blood and nerve energy following treatment. Evidence for this is anecdotal at best, but manipulation is unlikely to be harmful if causes treatable by other modalities have been ruled out.

For conditions such as cancer, fractures, infectious diseases, neurologic disease processes, and anything that may cause increase orthopedic fragility, chiropractic treatment alone is not an effective therapy, and may even be harmful in some cases.

Those who have known circulatory problems, especially with a history of thrombosis, should not have spinal manipulation.

Training & certification: Chiropractors are licensed by the state in which they practice. Matriculation at a certified school of chiropractic requires at least two years of science-based undergraduate work, and most applicants have completed a bachelor's degree. Chiropractic college is an additional four-year program, and graduates receive a D.C.